Stress activates your sympathetic nervous system, this is the where we can move into "fight, flight or freeze" mode. The sympathetic nervous system is responsible for keeping us safe when we are in danger, however it can be activated for prolonged periods and many of us lack the skills to return control to our parasympathetic nervous system, which is responsible for helping us to "rest and digest".

How would this affect pain?

During this state muscles become tense and ready for action, the nervous system is extra sensitive to stimulus, blood pressure is raised and we are more likely to notice and have negative thoughts. Tense muscles can become tired and sore or put extra stress on other structures, causing pain and irritation. Often when in a stressed state our breathing becomes shallow and rapid, even when not really exerting ourselves, such as while sitting in an office.

Use your breathing to recover.

An effective way to help your body return control to the parasympathetic nervous system is to consciously change your breathing. One method is to hold your breath for as long as you can, once you relieve your breath your body senses that a threat has passed and can return to a more relaxed state.
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Another commonly used technique is box breathing. To do this, breathe in for four seconds, hold for four, breathe out for four, hold again for four and repeat. Do this for a few minutes until you start to feel more relaxed and calm.

Show your body that you are safe.

Other activities that can help your body to relax include yoga, going for a swim or having a shower, or doing some intense exercise where your heart rate is raised.

Speak to your physiotherapist for more information on this topic and tips to help you relax during the day.

What are they?
 
The hamstrings are a large group of muscles located at the back of the thigh. Their job is to bend the knee, extend the hip backwards and stabilise the leg. The muscles can be injured at any point along their length but are most vulnerable where the tendon and muscle fibres join together. This is a common injury for players of all sports that involve running, and particularly those that involve quick movements and kicking. 

What are the causes?
 
As the hamstrings cross two large joints (the hip and the knee), they need to perform complicated movements, often activating suddenly and with great force. They are often stretched during a fall, a powerful kick of a ball or a sudden take-off. Factors that increase the chance of a tear include poor flexibility, strength or neural mobility. Other factors that contribute to hamstring injuries are muscle imbalances, abnormal lower limb biomechanics, fatigue, and inadequate warm-up. The biggest predictor of a future hamstring tear though, is a previous hamstring injury.
 
What are the symptoms?
 
The most common symptom of a strained or torn hamstring is a sharp pain at the back of the thigh, often immediately after intense activity. There may also be swelling, bruising, difficulty walking and pain with knee movements.
 
Your physiotherapist can confirm that the pain is due to injured hamstrings rather than any other issues, and tell you how bad the strain or tear is. Although not usually required, diagnosis can be confirmed by having an MRI or ultrasound scan.
 
How can physiotherapy help?
 
Once a diagnosis has been made, the first step is to follow the R.I.C.E protocol (Rest, Ice, Compression, Elevation). During the first 48 hours, you should apply ice for 20 minutes every one to two hours to reduce swelling and bruising. Consultation with your physio will include advice about your recovery, and when it is appropriate to return to sport. Your physiotherapist has many techniques that can promote healing and reduce scar tissue formation, which may include ultrasound, deep tissue therapy, electrotherapy and dry needling.
 
Crucially, they will also prescribe you an exercise program to return strength, flexibility and control to your muscles, getting you back to your sport quickly and safely. Due to the high chance of recurrence, rehabilitation is very important and usually takes 6-12 weeks. If the muscle is completely torn, surgery may be required before rehabilitation can start. Your physiotherapist will work with you to help you set goals to get you back to your favourite activities as soon as possible.

What is it?
A broken collarbone, or clavicle, is one of the most commonly broken bones in the body. The clavicle connects the front of the ribcage to the shoulder and is the only bony connection the arm has to the rest of the body. Many muscles attach to the clavicle, including the deltoid and pectoralis Major.

How does it happen?

The most common way for this injury to occur is through a fall onto the shoulder. This can happen from a simple fall or sports such as mountain biking or football. It is a common childhood injury but can happen at any age.
 
What are the symptoms?
 
Usually, a broken collarbone will cause moderate to severe pain over the broken area. The patient may have heard or felt a popping or cracking at the time of the injury and there may be an ongoing grinding or creaking with movements of the upper arm. If the skin is not broken there may be bruising and swelling over the painful area.
 
What is the treatment?

While very severe cases can be surgically fixed, more often a broken collarbone will be allowed to heal naturally with rest and monitoring. By supporting the arm in a sling and providing pain relief the arm will mend on its own. As with most fractures, there are often other injuries that need to be dealt with at the same time. There are many important structures near the collarbone that can be damaged, including muscles, nerves and blood vessels. In very severe cases, the lung tissue under the collarbone can be damaged causing the lung to collapse. 
 
Physiotherapy and recovery:
 
Once a treatment plan has been decided by your medical team, your physiotherapist can help you to return to your pre-injury strength and mobility with a full rehabilitation program.

What is it?
 
Your knee moves freely backwards and forwards; however, the thought of it moving from side to side probably makes you cringe. This is because the knee joint has sturdy ligaments either side of it that prevent sideways movement and we instinctively know that a lot of force would be required to shift it in this direction. 
 
The ligaments on either side of the knee are called the collateral ligaments and they each work to provide stability and restrict the knee’s movement into a sideways direction. The medial collateral ligament (MCL)  is found on the inside of the knee and acts to prevent the knee bending inwards towards your other leg.

How does this injury occur?
 
The typical mechanism for this injury is a force that drives the lower leg inwards. This can occur from an awkward landing from a height, or when twisting with a foot fixed on the ground or from an external force hitting the outside of the knee, such as with a football or rugby tackle.
 
What are the symptoms?
 
MCL tears typically create pain and swelling quite specifically on the inside of the knee. The severity of the pain and swelling will be related to the amount of ligament fibres damaged. Larger tears may also make the knee feel unstable or loose. 
 
A grading system is used to classify the severity of the injury and help to guide treatment. Grade 1 indicates that a few ligament fibres have been torn and grade 3 is used for a complete tear of the ligament with associated joint laxity. Very severe MCL tears may also involve injury to the medial meniscus and anterior cruciate ligament (ACL) and can require surgical repair. However, most MCL sprains can be managed well with physiotherapy. Grade 1 and 2 MCL sprains take between 3-8 weeks to fully heal and a complete rehabilitation program is strongly recommended to prevent future injury.  
 
How can physiotherapy help?

In the early stages of the injury, treatment is focused on pain and swelling management, while allowing the body to start the healing process. This is best managed thought the R.I.C.E. principles (Rest, Ice, Compression and Elevation). 
 
Following any injury, it is natural for muscles to waste a little and the damaged tissues to lose what we call proprioception, the ability to sense their position in space. This loss of muscle strength and proprioception can contribute to future injury if not restored with a proper rehabilitation program. 
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Physiotherapy also aims to restore movement to the joint and support the ligament while healing to ensure that it is strong and healthy, and the scar tissue forms in an organized fashion, which makes the new ligament as strong as it can be and protects against future tears.

A serious injury of the knee is a tearing of the ACL (Anterior Cruciate Ligament). This ligament is  important for stability of the knee and may need to be repaired surgically. The primary function of the ACL is to keep the bottom surface of the knee joint from sliding forwards during movement. An unrepaired knee may feel unstable or give way suddenly.
 
Not all ACL injuries require surgery and some may heal well with proper rehabilitation, however for those who do need surgery, there is a significant rehabilitation period afterwards.

What does the surgery consist of?
 
Each surgeon will have a slightly different technique for surgery. The most common approach is the arthroscopic approach, which uses a small camera and allows the surgeon to make only small incisions into the knee. They will then replace the torn ligament with either a graft from a tendon or ligament at another part of the body or using a synthetic graft.
 
How long does rehabilitation take?
 
Full rehabilitation following surgery can take 9 to 12 months and is divided into different stages. As surgeons can have different protocols for their approaches to surgery, time frames will vary for everyone. 
 
Initially after surgery, the graft will be quite weak while a new blood supply is being established. It can take up to 12 weeks before the graft is at its strongest point and evidence suggests that it may never have the strength of the original ligament.
 
In the early stages, rehabilitation will be focused on restoring movement to the joint and strengthening the muscles around the knee without putting any undue stress on the graft.
 
As the graft begins to heal and strengthen, rehabilitation can progress to include stability and control exercises and gradually build up to a complex program that prepares the knee for a full return to sport.
 
The path to full rehabilitation from a knee reconstruction can be a long and bumpy one, however, there are high success rates with this surgery, particularly when followed up with full physiotherapy rehabilitation.

There is no doubt that the human body can be resilient. The body is capable of recovering from amazing amounts of damage, including broken bones. Perhaps because of this, some people feel that physiotherapy treatment can only speed up recovery and if they are not elite athletes then simply letting nature take its course is the best, most cost-effective choice for them. 
 
Speed of recovery, however, is only one small measure of physiotherapy success and fails to fully represent how important proper treatment is. Here are a few things about injury healing you may not have been aware of.

1. Scar Tissue is more likely to form without treatment. 
Scar tissue can cause ongoing pain and stiffness in your tissues. Physiotherapy can prevent excess scarring through advice regarding movement, massage and other hands-on treatment. 
 
2. Your ability to sense the position of your body, known as proprioception, is often damaged after an injury and can be retrained.  
Impaired proprioception is a major factor in reinjury. If you’ve ever heard someone say “my knee/ankle/shoulder still doesn’t feel 100%” then this could be why. Physiotherapy treatment will aim to restore proprioception as a part of your rehabilitation. 
 
3. Once healing has finished, your body may not be quite the same as before.  
Injured ligaments may be weaker, damaged muscles and joints may be stiffer and tighter. While the original pain may resolve, there may still be some residual issues that need to be addressed to prevent reinjury. 
 
4. You may have picked up some bad habits while waiting for the injury to heal.  
While in pain we often change the way we do things, which can lead to the development of poor movement patterns and muscle imbalances. Even though the pain has gone, these new patterns can persist and create further problems down the road. 
 
5. Injuries don’t always heal completely. 
On occasion, circumstances may prevent an injury from healing fully. The most serious example of this would be a fracture that cannot heal if the bone is not kept still enough. Other factors that may prevent an injury from healing include poor circulation, diabetes, insufficient care of the injury and poor nutrition. Your physiotherapist can guide you on the best path to a more complete recovery from any injury.

Back pain is such a common experience that it is estimated up to 80% of adults will have at least one severe episode of lower back pain in their lifetime. 
     
For many people, the pain quickly resolves and things go back to normal. However the first time this happens to you it can be scary, particularly as severe pain can occur suddenly and without warning. 
 
Statistics however are on your side. Most of the time, acute low back pain resolves without consequence and doesn’t recur. If you happen to be in the middle of an episode though, here are a few tips to help you get through.

1. Avoid heavy lifting

 
While this may seem obvious, there are a few people who will always try to push through the pain. The expression "no pain, no gain" is in many cases outdated and if your work requires heavy lifting, it is more than reasonable to take a few days off. 
 
2. Avoid too much rest.
 
On the other hand, lying in bed all day is bad for you as well. If you have severe back pain, gentle movement under the advice of a physiotherapist is much better for you than complete rest. 
 
3. Avoid long car or plane trips
 
If possible, now is the time to avoid long distance travel. If you absolutely must travel, speak to your physiotherapist about how to manage your pain during the trip. 
 
4. Avoid listening to horror stories
 
There are always stories about pain that never went away, requiring surgery, which only made it worse. While worst case scenarios can happen, they are rare, and being fearful can negatively impact your recovery. That terrible story is probably not going to happen to you and hearing these stories is only going to worry you and make you feel worse!
 
5. Avoid delaying treatment
 
While your pain may go away on its own, it is important to have a professional assess your condition to screen for any serious injuries and advise you on how to best manage your pain while you are getting better. They can also help you recover as quickly as possible, as well as give you advice on how to avoid future episodes.
 
6.   Don’t expect a miracle cure
 
Back pain is complicated and a single treatment that works for everyone simply does not exist. It is important to follow the directions of your therapist and work with them to set reasonable and realistic goals for your recovery. 
 
None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.